| CREDIT
CARD FAX FORM-AO NANG PAKASAI |
| I hereby authorized AO NANG PAKASAI RESORT, KRABI to charge the amount of THAI BAHT .
from :
to:
Cardholder's Name : (as it appears on card) Guest's Name : (if different from above) Card Number : Master Card : write down the last 3 digits show on the back of the card : AMEX : please inform Billing address Expiry date : Card company : Country: SIGNATURE : _______________________________ Date : _____________________ *********************** IMPORTANT ********************** Please
kindly print this form, fill-in your details and fax it back to our Bangkok Office
at
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